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Fort Payne MRI, LLC

Details

Name: Fort Payne MRI, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 06 Sep 2005 (19 years ago)
Entity Number: 000-468-701
Register Number: 000468701
County: Montgomery
Place of Formation: Montgomery County
Registered Office Street Address: 7094 UNIVERSITY COURTMONTGOMERY, AL 36117
Registered Office Street Address ZIP Code: 36117
Principal Address: MONTGOMERY, AL

Activities MAGNETIC IMAGING FACILITY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1730145988 2006-04-25 2008-02-22 1110 GLENN BLVD SW, SUITE 100, FORT PAYNE, AL, 359678486, US 1110 GLENN BLVD SW, SUITE 100, FORT PAYNE, AL, 359678486, US

Contacts

Phone +1 256-845-9402
Fax 2568459410

Authorized person

Name JAMES W. HOLMES
Role CHIEF OPERATING OFFICER
Phone 3372919161

Taxonomy

Taxonomy Code 2085R0202X - Diagnostic Radiology Physician
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 051557560
State AL

Central Index Key

CIK number Mailing Address Business Address Phone
1342665 2170 ROSEMONT DR, MONTGOMERY, AL, 36111 2170 ROSEMONT DR, MONTGOMERY, AL, 36111 334-834-1300

Filings since 2005-10-24

Form type REGDEX
File number 021-82590
Filing date 2005-10-24
File View File

Agent

Name Role Address
BARNETT, ROSS W Agent 255 ALBERT RAINES BLVDGADSDEN, AL 35901

Member

Name Role
OPEN MRI OF ALABAMA LLC Member

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State